急性肾小球肾炎697例流行病学调查

Epidemiologic Investigation in 697 Cases of Acute Glomerulonephritis

目的探讨急性肾小球肾炎（AGN）的流行病学、临床特征及转归。方法回顾性分析重庆医科大学附属儿童医院1996年1月-2005年12月697例AGN住院患儿的临床资料,分析其流行病学特点、前驱感染及病原学资料,并对其临床特征、病情、转归及预后进行综合分析。采用SPSS10.0软件进行统计学分析。结果AGN患儿697例占同期住院患儿的3.5‰,占泌尿系统疾病患儿的18.3%。一年四季均有发病,以11月-次年1月为发病高峰,8月份发病人数最少。一、二、三级亲属曾患AGN分别为24例（3.4%）、31例（4.4%）、2例（0.3%）。前驱感染中,405例（58.1%）为呼吸道感染,194例（27.8%）为皮肤感染,98例（14.1%）无明确前驱感染。呼吸道和皮肤感染至发病的间隔时间分别为（11.2±5.9）、（19.1±8.4）d。病原血清学检查中,抗链球菌溶血素（ASO）阳性检出率为66.7%、柯萨奇病毒（Cox）检出阳性率为53.6%,Cox抗体阳性的病例中57.8%并ASO增高。支原体抗体在2003-2005年检出率分别为0、18.8%、35.0%。697例中并严重循环充血21例（3.0%）,高血压脑病36例（5.2%）,急性肾功能不全42例（6.0%）。出院时治愈507例（72.7%）,好转138例（19.8%）,未愈51例（7.3%）,死亡1例（0.1%）。结论链球菌仍是近10aAGN的重要病因。AGN在同期住院患儿中比例呈降低趋势,而并急性肾功能不全的发病率并未降低。

Objective To explore the epidemiology,clinical characteristics and prognosis of acute glomerulonephritis （AGN） . Methods The study was designed to investigate the admission rate and diversity of 697 children with AGN in hospitalized patients from Jan. 1996 to Dec. 2005, and analyze epidemiology, etiology, clinical characteristics and prognosis. Results Six hundred and ninety- seven cases of AGN accounted for 3.5% of the hospitalized children and 18.3% of urinary disease children. The cases were shown in each month of the year, mainly in Nov. , Dec. , and Jan. , least in Aug. Twenty -four （3.4%）cases of AGN were detected among first degree relatives, 31 （4.4%） and 2（0.3% ） cases among the second and the third degree relatives. Of 697 cases 405（58.1% ） were induced by respiratory infection,194 （27.8%） skin infection and 98（ 14.1% ） without determined infection. The time from respiratory infection and skin infection to AGN was （11.2 ± 5.9）days to（ 19.1 ± 8.4 ）days. Etiology analysis showed that the positive detection rate of antistreptolytin O （ASO）was 66.7%, Coxsackie（Cox） virus 53.6% ,while 57.8% with ASO positive in Cox virus cases. The positive detection rate of mycoplasma was 0,18.8%, 35.0% in 2003,2004,2005. Of 697 cases,21 （3.0%） were complicated with serious circulation hyperaemia,36 （5.2%） with hypertensive encephalopathy,42（6.0% ） with acute renal insufficiency. Complete remission was noted in 507 out of （72. 7% ） while 1 （0. 1% ） died of AGN. Conclusions During the past 10 years,streptoc coccus infection was still the main cause of AGN. The incidence was declining for the hospitalized patients with AGN, but there was no improvement on the incidence of acute renal insufficiency.